Coordinating TRICARE For Life with Other Health Insurance besides Medicare
How Medicare coordinates with other health insurance (OHI) depends on whether or not the OHI is based on current employment. In either case, TRICARE for Life is the last payer. If you have OHI that is not based on your or a family member’s current employment, Medicare pays first, the OHI pays second, and TRICARE for Life pays last.
OHI Based on Current Employment
Generally, if you have an employer-sponsored health plan based on current employment, that health plan pays first, Medicare pays second, and TRICARE for Life pays last. If there are fewer than 20 employees in the employer-sponsored plan, Medicare pays first, the employer plan pays second, and TRICARE for Life pays last. Please note: TRICARE for Life pays after most insurance plans with the exception of Medicaid, TRICARE supplements, the Indian Health Service, and other programs and plans as identified by the Defense Health Agency. For more information on how TRICARE for Life works with OHI please visit TRICARE's using other health insurance page.
Frequently Asked Questions related to how TRICARE For Life works with Other Health Insurance
Do you pay for the Medicare Part B premium?
The Part B monthly premium is your responsibility. TFL covers the Medicare Part B deductible as long as the health care service is covered by both Medicare and TRICARE for Life.
Should I cancel my Supplement, Advantage Plan, or OHI?
Be sure to carefully weigh your options before making any changes to your health insurance. You want to be sure to choose what suits your own needs. You can discontinue your Medicare supplement, Medicare Advantage, or OHI, but that may or may not be a good decision. Contact your local State Health Insurance Assistance Program for free health insurance counseling and assistance.
Do I need to contact TFL if I drop my OHI coverage?
Yes, you should notify TFL immediately. We need this information to properly process your claims. If you already have an online account, you can update your information in the Family Profile area. You can also complete the Other Health Insurance Questionnaire and mail or fax it; the contact information is on the bottom of the form. Or you can call 1-866-773-0404 and we will assist you..
How do I file a claim that includes OHI payment information?
When your OHI processes the claim after Medicare, you or your provider can submit a claim to TRICARE For Life for any remaining balance. You must include a Patient's Request for Medical Payment (DD Form 2642), along with the supporting Medicare and Other Health Insurance Explanation of Benefits (EOB). You can file your claims online through our message center. If you don’t already have an account, you can create one. If you prefer to file the claim by postal mail, send it to:
WPS/TRICARE For Life
P.O. Box 7890
Madison, WI 53707-7890